[Cardiac arrhythmia in amitriptyline poisoning in children]. / Tulburari de ritm cardiac in intoxicatia cu antideprin la copil.

UNLABELLED: Amitriptyline (Antideprin) determines severe intoxications, especially because of its cardiac side effects. METHOD: We studied 8 children (2-14 years old) admitted with signs of amitriptyline intoxication. RESULTS: The clinical picture revealed altered general status, generalized hypertonia, arterial hypotension up to collapse, mydriasis, coma and cardiac arrhythmia. ECG monitoring showed ventricular premature beats, isolated, couplets and triplets, ventricular tachycardia and torsade des points, severe ventricular repolarisation disturbances with diffuse subendocardial ischemia. The treatment consisted in: gastric lavage with activated charcoal, alkalinisation with sodium bicarbonate, antiarrhythmic drugs and sustained vital functions. All cases recovered in 4-6 days. CONCLUSION: The severity of amitriptyline intoxication requires continue clinical and ECG monitoring, for early detection of some life threatening cardiovascular events. Thus, the treatment will be started early and will alleviate the severe prognosis of this intoxication.

[Aspects of left ventricular function in children with chronic renal failure]. / Particularitati ale functiei ventriculului stâng la copiii cu insuficienta renala cronica.

OBJECTIVE: To present the main morphological and functional cardiac modifications in children with chronic renal failure (CRF) and the effect of hemodialysis on systolic function of the left ventricle (LV). METHODS: 22 patients (5-19 years) with CRF of different degrees of severity. 16 of them were included in a hemodialysis (HD) program and they were followed-up for at least 1 year. The systolic and diastolic function of the LV were investigated by echocardiography (echo) 2D and Doppler. RESULTS: Although the clinical signs of cardiac suffering were rare, echo detected concentric hypertrophy (9 cases), dilated cardiomyopathy (4 cases), mitral and tricuspidian regurgitation and pulmonary hypertension (3 cases) and pericardial effusion (10 cases). Systolic function was normal in most of the cases, but the diastolic function (evaluated by E/A ratio, isovolumic relaxation and deceleration time) was modified in 10 cases. The HD session induced the improvement of the LV systolic function parameters and the decrease of right ventricle dimensions. CONCLUSIONS: Echocardiography has a higher sensitivity compared to ECG and chest X-ray in evaluation of the LV function, mainly in the cases without cardiac symptoms. An efficient chronic HD program and also a complex antihypertensive treatment contribute to the alleviation of the LV function. For the HD session, echo is useful in monitoring the systolic LV function.

The value of echocardiography for the assessment of the cardiac impairment in chronic renal failure in child.

UNLABELLED: Chronic renal failure (CRF) might gradually induce the occurrence of morphological and functional cardiac disturbances; these cardiac disturbances make up supplementary risk factors in children with CRF. The aim of our study was to determine the role of echocardiography(Echo) for the diagnosis of these cardiac disturbances acquired during the evolution of CRF in child. We studied 20 patients(aged between 5 and 18 years) with CRF, from whom 13 were dialysed. All patients underwent 2D echocardiography with Doppler, including the study of systolic and diastolic function of the left ventricle(LV). The main echocardiographic findings were:--concentric LV-hypertrophy(8 cases) and asymmetrical LV-hypertrophy(3);--dilated cardio-myopathy(3);--diastolic dysfunction of the LV(10);--normal systolic function in most of the cases;--mitral and tricuspid regurgitation(3);--pulmonary hypertension(2);--pericardial effusion (8) to cardiac tamponade (2). Echo allowed a better assessment of cardiac morphology and LV function and their improvement in some cases, after hemodialysis and antihypertensive therapy. CONCLUSION: Echo exam has a great utility for the diagnosis of cardiac disturbances in children with CRF, especially in cases with severe cardiac involvement and without cardiac symptoms; this investigation has to be performed right since the initial diagnosis, as well as for long-term surveillance.

[The morphofunctional characteristics of cardiac involvement in arterial hypertension in children]. / Particularitati morfo-functionale ale afectarii cardiace în hipertensiunea arteriala la copil.

UNLABELLED: The aim of the study was to investigate the main morphofunctional aspects of the cardiac involvement in systemic hypertension in child. METHODS: 48 children with aged ranging between 2 months-18 years, diagnosed with systemic hypertension (SH), were followed up more than 1 year (with treatment) and investigated by clinical examination and noninvasive methods. The etiology of SH was: * secondary SH (40 cases): acute (8) and chronic nephropathy (20), 13 cases being dialysed; coarctation of aorta (10) and pheochromocytoma (2 cases) and * essential SH (8 cases): "borderline" type and also confirmed. RESULTS: The echocardiographic findings had a superior sensibility to ECG and chest X-ray findings, concerning cardiac involvement in SH, especially in the secondary forms, with high values of systolic and/or diastolic blood pressure and with a long period of evolution: hypertrophy of the left ventricle (LV) (31 cases = 65%) with septal predominance (10); * alteration of diastolic function of LV (11), but with normal systolic function of LV (all the cases). These changes have not been observed in acute nephropathy or they were unsignificant in essential SH. Repeated echocardiography after minimum 6 months proved a varied regression of hypertrophy of LV and improved diastolic function of LV in children who received antihypertensive therapy, including spironolactone and/or angiotensin converting enzyme inhibitors. CONCLUSION: Because such cardiac involvement are important and of greater risk factor for the hypertensive patients, the early diagnosis by echocardiography, the follow up of the evolution and the diminish of cardiac disorders by the treatment mentioned above, may improve the prognosis of the disease.

Etiological, clinical and pathomorphological aspects of acute respiratory distress syndrome in children.

Acute respiratory distress syndrome (ARDS) is the result of severe injuries of different etiologies of the capillary system in patients with previously healthy lungs, resulting in noncardiogenic pulmonary edema. The authors studied 42 infants in whom the histopathologic aspects were suggestive for ARDS. The etiologic factors of this syndrome were: severe gastroenteritis with hypovolemic or endotoxic shock (13 cases), sepsis (9 cases), fulminans purpura (2 cases), severe neurological disorders (13 cases), pulmonary infections (5 cases). In such conditions, if the infant presents hyperpnea followed by generalised cyanosis, refractory to oxygen therapy, and if there are clinical and radiologic signs of acute pulmonary edema, the diagnosis of ARDS must be considered and a complete intensive care therapy is compulsory in order to alleviate the severe prognosis of this syndrome.

Value of intravenous ATP in the diagnosis and treatment of tachyarrhythmias in children.

Actual researches show that adenosine and its forerunner, ATP, can realise a nodal block in intravenous (i.v.) administration. This effect, even if transient, is of particular usefulness in the therapy of paroxysmal supraventricular tachycardia (PST) in children and adults. 1 mg/kg ATP was administered i.v. to 51 children (aged 3 months to 15 years) admitted to the Intensive Care Unit for severe regular paroxysmal tachyarrhythmias with clinical and ECG symptoms. In 31 cases, the P wave was absent on ECG. In 6 of 31 cases in whom wide QRS complexes were found (over 0.10 sec), a WPW syndrome (4 cases) or bundle branch block (2 cases) was associated. Rapidly i.v. administration monitored electrocardioscopically was followed by ending of PST in 43 children, including those with wide QRS complexes. The highest effectiveness was in junctional tachycardia by re-entering mechanism. The drug was well tolerated, had no side effects or hemodynamic disturbances and this is very important, because in 12 infants already existed symptoms of congestive cardiac failure at their admission. The use of i.v. digoxin with/without propranolol was necessary in 8 cases, in which the repeated ATP administration was ineffective. We consider that i.v. ATP administration in regular tachyarrhythmias in children is very useful for the proper diagnosis of the types with wide QRS complexes and/or when the P wave did not appear on the ECG, and also for the treatment, because ATP has a high effectiveness and an excellent tolerance.

Clinical and evolutive aspects in ventricular preexcitation syndromes in child.

Ventricular preexcitation syndromes (VPS) are very important between cardiac rhythm disturbances in childhood, because their presence can change the clinical and ECG picture and thus the treatment can be very difficult. The authors studied 58 cases of VPS in children (2 weeks-15 years old) admitted in a period of 3 years. The surface ECG showed VPS aspects: in 30% of cases we noticed WPW syndrome type B and the rest presented VPS with Mahaim pathways and Lown-Ganong-Levine syndrome. 4 cases were familial and 1 child a hidden WPW syndrome. In 65% of cases the cardiac symptoms put the diagnosis and 1/3 of cases were discovered by common ECG. The most important cardiac sign of the children with WPW syndrome was the paroxysmal supraventricular tachycardia, 4 cases presenting wide QRS complex. Others types of VPS were without clinical symptoms. The intravenous administration of digoxin + propranolol was the therapy of choice for paroxysmal supraventricular tachycardia in infants and children until 2-3 years old, and propranolol and chinidine after this age. The children older than 2-3 years and/or those with ineffective preventive for recurrent treatment received dysopiramide and specially amiodarone with satisfactory results; it was not necessary the surgical ablation of the aberrant pathway. Ventricular preexcitation syndromes and wrong treatment can induce severe ventricular arrhythmia, so all the tachyarrhythmias with unknown etiology and especially those with wide QRS complex must be investigated very carefully, using and Holter test and the endocavitary electrophysiology, for a correct medical and/or surgical treatment.